Provider First Line Business Practice Location Address:
1215 CENTRAL AVE S
Provider Second Line Business Practice Location Address:
STE 205
Provider Business Practice Location Address City Name:
KENT
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98032-7443
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-630-3614
Provider Business Practice Location Address Fax Number:
253-630-9810
Provider Enumeration Date:
11/29/2006